Sunset syndrome is a series of disorders that can occur in the elderly that occur at a specific time of the day, that is, in the late afternoon, evening or night. The symptoms of the sunset syndrome lead to difficulties for the person experiencing them, but also for the caregivers taking care of such a senior. However, what are the problems associated with this disorder and what are the causes of sunset syndrome?

The sunset syndrome(sometimes also referred to as sundowning) is a syndrome that often surprises caregivers of the elderly. Caring for a chronically ill close person who requires constant help is certainly a serious challenge.

Caregivers often have to devote their free time, but also learn to carry out many different care procedures (for example, methods of preventing pressure ulcers or replacing catheters). People who care for seniors close to them often also encounter phenomena that they do not understand - one of them may be the sunset syndrome.

Sunset syndrome: causes

Sunset syndrome is typically associated with different types of dementia. It is most often associated with Alzheimer's disease - it turns out that in 20 to even more than 40% of patients with this disease, symptoms of the syndrome may appear to varying degrees.

The mere connection with dementia disorders was not enough, however, for scientists who decided to search for the causes of the sunset syndrome.

It is suspected that one of them may be neurodegeneration processes, such as the death of neurons and leading to dysfunction of the nervous system centers responsible for controlling the sleep-wake cycle.

Generally, however, it should be emphasized here that the exact pathogenesis of the setting sun has not been known so far. Just as the pathological processes mentioned above may explain its occurrence in some way, it is unknown why in some elderly people who do not suffer from any dementia at all, sunset syndrome can also occur.

Sunset Syndrome: Risk Factors

The underlying problem that canlead to the occurrence of sunset syndrome in a senior, there are various dementia disorders mentioned above.

However, other factors are also mentioned that may also contribute to its development - they are, among others, the sudden arrival of an elderly patient in the hospital (e.g. due to pneumonia), experience of severe stress (e.g. related to a visit to the doctor's ) or, after many years of living at home, moving to a completely different place (e.g. to a children's home or a nursing home).

Sunset Syndrome: Symptoms

The sunset syndrome is associated with cyclical ailments that appear at similar times of the day.

Characteristic for this unit are changes in the behavior of seniors that take place in the afternoon, evening or night hours.

The symptoms of the sunset syndrome are related to the upcoming evening time (and the associated sunset, leading to a reduction in the amount of light outside) and can be:

  • strong anxiety, fear in the senior
  • agitation (sometimes even leading to the senior screaming for no reason or becoming aggressive even towards his household members)
  • confusion (mostly about time and place)
  • difficulties with recognizing even close people
  • sleep disorders (consisting in difficulty falling asleep, but also waking up frequently at night)
  • visual hallucinations
  • difficulty speaking
  • disturbed thinking (a patient with sunset syndrome may have difficulties with reasoning)
  • mood swings (patients with sunset syndrome often become very irritable in the evening hours)

The symptoms of sunset syndrome can be completely incomprehensible to people who care for a patient with this disorder.

As already mentioned several times here, they appear cyclically and in fact in the morning a patient who was restless the previous evening, not aware of where he was or who even showed overt aggression, for day it can function without major irregularities.

Sunset Syndrome: Possible Complications

Since the band's manifestations may subside after sunrise, it might seem that the problem is quite trivial.

Nothing could be further from the truth - sunset syndrome can cause a wide variety of problems. First of all, this unit - due to the fact that it causes sleep disorders - can lead to the fact that during the day the senior will simply be sleepy andas a result, he will have much less energy (which, in turn, may make it difficult for him to take part in, for example, rehabilitation classes).

In addition, the older person's behavior in the evening hours is dangerous - by agitation or aggressive behavior, there is a risk that the patient will harm someone else or even himself.

Sunset Syndrome: Diagnostics

In fact, there are no studies that would make it possible to conclude on the syndrome of the setting sun. This problem does not appear in the medical classifications of various diseases (such as ICD-10 or DSM-5), so it is also difficult to say whether the patient's behavior definitely corresponds to this disorder.

It is safe to say, however, that a patient who develops problems consistent with the symptoms of sunset syndrome should be examined by a doctor.

First of all, it is necessary to exclude the existence of various diseases in the course of which similar ailments may appear. This is primarily about Parkinson's disease, delirium and sleep disorders.

Sunset Syndrome: Treatment

Families of seniors suffering from sunset syndrome often expect that they will obtain some medications from doctors, thanks to which the symptoms of this problem will no longer appear in their relatives. In practice, however, the most important in people who struggle with this abnormality are non-pharmacological effects.

First of all, it is recommended to take care of the appropriate conditions in the room where the senior is staying. The band appears in the evenings, incl. because then it is much less bright in the living spaces - it may lead to the fact that the elderly person will experience difficulties with recognizing the environment and therefore may become anxious.

For this reason, it is worth taking care of the lighting - of course, it is not about maintaining the level of lighting in the room as it prevails in it on a sunny day, but placing it in the bedroom (and leaving it on all night) may help. an ordinary, even small lamp.

When your loved one starts to show problems related to the sunset syndrome in a given evening, it is worth trying to distract him.

It can be helpful to turn on the TV (however, it should broadcast a rather calm movie - a horror movie or a war movie may intensify the senior's anxiety), music or even a simple, calm conversation.

Incentives to focus onthen the patient should be of moderate intensity. Clear sounds of children playing or very loud music may result in the intensification of the symptoms of the sunset syndrome.

Sleep hygiene is also important for the condition of people with sunset syndrome. It is recommended that patients always go to bed and get up at the same time - regularity in this aspect may reduce the sleep disturbances associated with the syndrome.

You should also pay attention to the seniors falling asleep during the day - one nap at noon should not hurt, but when it takes place later in the afternoon, it may already make it difficult to sleep.

Sometimes, however, the non-pharmacological effects alone turn out to be insufficient, and then specific pharmacological treatment may be considered in a patient with sunset syndrome.

There are reports of benefits in people with this melatonin disorder. In a situation where the patient is often strongly agitated and aggressive, agents from the group of neuroleptics (antipsychotics, such as e.g. quetiapine) can be used, usually in low doses.

About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

Category:

Psychiatry